Wk 1 Pneumonia Flashcards
Define pneumonia
ANY type of infection of the LOWER respiratory system
There are many etiologies for pneumonia such as…
Fungal, protozoa, viral, bacterial, parasitic
What does pneumonia do?
Causes inflammation of the lung tissues, the alveolar air spaces become filled with purulent, inflammatory cells, and fibrin
How is pneumonia transmitted?
Inhaled infectious droplets
What season is pneumonia most prevalent?
Winter
What gender is pneumonia more prevalent?
Males
List 9 risk factors for pneumonia
1) Age extremes, elderly or children less than 5
2) Immunocompromised
3) Underlying lung disease
4) Alcoholism
5) Altered LOC
6) Dysphasia
7) Long term care facility
8) Hospitalization
9) Influenza
Pneumonia usually starts as some sort of __ __ __
upper respiratory infection
Why is alcoholism a risk for pneumonia?
Aspiration risk
Why is altered LOC a risk factor for pneumonia?
Aspiration risk
Why is hospitalization a risk factor for pneumonia?
Tracheal intubation or LOC issue
What are the two classifications for pneumonia?
Community acquired pneumonia and hospital acquired pneumonia
Community acquired pneumonia is one of the most common reasons for __
hospitalization
Hospital acquired pneumonia develops within __ hours after admission
48 hours
Which classification has better outcomes?
Community acquired pneumonia
Hospital acquired pneumonia is typically associated with __ care.
ICU
Pneumonia associated with endotracheal intubation
Ventilator associated pneumonia
What is the most common route for pathogenesis of pneumonia?
aspiration of oropharyngeal secretions
Once the pathogen is in the lower airways, what happens in the pathogenesis of pneumonia?
Inflammation causing vasodilation, infection spreads to alveoli
When the alveoli are infected, this causes goblet cells to…
secrete mucus between the alveoli and capillaries preventing gas exchange
How does the sputum in between the capillaries and alveoli prevent gas exchange?
Alveoli attempt to open and reclose against the purulent exudate but many cannot making gas exchange less than optimal
What three things contribute to the pathogenesis of pneumonia?
1) failure to cough reflex
2) Mucociliary clearance mechanism
3) Immune system
What causes the exudative fluid to move into the alveoli?
Failure of the mucociliary defense mechanism
Why are smokers at much higher risk for pneumonia?
Their mucociliary defense mechanism are already ineffective
What are the symptoms of pneumonia?
Fever, chills, productive or dry cough, malaise, pleural pain, sometimes dyspnea and hemoptysis
What is pleural pain?
Chest pain with breathing
What type of bacteria is usually found in hospital acquired pneumonia?
gram-negative
Bacterial pneumonia is typically acquired where?
In the hospital
Viral pneumonia is typically acquired where?
In the community
What does someone with severe pneumonia look like?
Tachypnea, signs of respiratory distress/failure
People who are in respiratory distress still maintain oxygenation by…
increased work of breathing
Someone who is in respiratory failure has increased work of breathing yet…
cannot compensate for inadequate oxygenation
What are symptoms of respiratory distress?
Tachypnea, nasal flaring, pursed lips, stridor, wheezing, agitation, tachycardia, pale, slow cap refill
What are symptoms of respiratory failure?
RR over 60, retractions, grunting, mottling, head bobbing, bradycardia, hypotension
What does respiratory arrest look like?
Bradypnea, inefficient respirations, cyanosis, no air movement
What do wet breath sounds sound like?
Rhonchi
Sections of your lungs that have a bunch of mucus in them
Pulmonary consolidations
What do pulmonary consolidations sound liek on percussion?
Dullness
What do pulmonary consolidations sound like on auscultation?
Inspiratory crackles
What might someone with pulmonary consolidations have if you are feeling their back?
Increased tactile fremitus and egophony
What is tactile fremitus?
refers to the vibration of the chest wall that results from sound vibrations created by speech or other vocal sounds
What is egophony?
Change from e sounds to a sound when speaking due to fluid accumulation in the lungs
What are diagnostic tests for pneumonia?
1) chest x ray
2) CBC with diff
3) sputum for c&S
What on a CBC would indicate pneumonia?
Leukocytosis
What are you looking for on a chest x ray for pneumonia?
Infiltrates
If bacterial pneumonia is gram positive, it is usually __ __
staph aureus
What does someone usually get staph aureus bacterial pneumonia?
Enters through the blood stream via IV routes and travels to the lungs
What is the most common cause of gram positive hospital acquired pneumonia?
MRSA
What is the most common organism associated with gram-positive community acquired pneumonia?
Streptococcus pneumoniae
How does someone in the community get streptococcus pneumoniae?
They get strep throat and then it spreads to pneumonia
Steptococcus pneumoniae cause of pneumonia is often called __ __
Pneumococcal pneumonia
With pneumococcal pneumonia, the sputum is normally what color?
Brown or rusty colored
What type of bacteria makes you the sickest?
gram-negative infections
What are three examples of gram-negative etiologies for pneumonia?
Pseudomonas auruginosa, Aceinetobacter, Klebsiella pneumoniae
Bacterial pneumonia that is acquired in the hospital is often from a __ __ infection/contamination
central line
What is aspiration pneumonia?
Material from the GI tract stimulated an inflammatory reaction
The severity of the inflammatory response to aspirate in the lungs depends on what?
The pH of the aspirate
The more __ the aspirate the greater the inflammatory response
acidic
What type of medication decreases the acidity of gastric contents that we give to patients with aspiration pneumonia?
proton pump inhibitor
Aspiration pneumonia can be __ or __
silent or abrupt
Most common cause of viral pneumonia
Influenza
Most common cause of community acquired pneumonia
Influenza
What do viruses do that puts the patient as risk for secondary bacterial pneumonia?
Alter the pulmonary immune defense making lungs vulnerable to bacterial infection
With viral pneumonia, what is the prognosis in healthy people?
Good, usually improves in 2-3 weeks
What is type of atypical pneumonia etiology is most common in HIV-infected persons or transplant patients?
Pneumocystis carini pneumonia
What type of organism is Pneumocystis carini pneumonia?
Yeast
What is the etiology of “walking pneumonia”?
Mycoplasma
Atypical pneumonia caused by mycoplasmas are usually
mild
What are the symptoms caused be mycoplasma atypical pneumonia?
Persistent cough, headache, earache
Mycoplasma is a bacteria-like organism and contrains…
properties of both bacteria and viruses
What type of atypical pneumonia is spread via water systems?
Legionella
What type of organism is Legionaella
gram-negative bacteria
Legionella pneumonia can be very __
deadly
Legionella pneumonia is also called
Legionnaire’s disease
What do you have to do if a patient is confirmed to have Legionnaire’s disease?
Report it to the health department
What type of atypical pneumonia is released from walls of old buildings?
Aspergillus pneumonia
Aspergillus is what type of organism?
Fungus
Aspergillus pneumonia can be very deadly to those who are __
Immunocompromised
What are 4 measures to treat pneumonia?
1) ensure ventilation/oxygenation
2) Adequate hydration
3) Good pulmonary hygiene
4) Nebulizer treatments
What pneumococcal vaccine is the PVC13?
Prevents pneumococcal pneumonia caused by 13 strains of strep
What pneumonia vaccine is the PPSV23?
Prevents against an addition 23 types of pneumonia bacteria
You can give PVC13 to __ in a series of 4 doses
Infants
Both PVC13 and PPSV23 can be given to the elderly if they are not…
do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant
